Healthcare Provider Details

I. General information

NPI: 1326406216
Provider Name (Legal Business Name): CLOVIS COMMUNITY COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10309 N WILLOW AVE
FRESNO CA
93730-5401
US

IV. Provider business mailing address

10309 N WILLOW AVE
FRESNO CA
93730-5401
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-5200
  • Fax:
Mailing address:
  • Phone: 559-325-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateNULL

VIII. Authorized Official

Name: LORRIE HOPPER
Title or Position: VICE PRESIDENT
Credential:
Phone: 559-325-5238